Cirrhosis Flashcards
define cirrhosis
irreversible scaring and fibrosis of the liver w/ nodules
what are causes of cirrhosis?
chronic liver disease
1. viral infection (HBV, HCV)
2. toxins - alcoholic liver disease
3. hereditary conditions
4. autoimmune processes
5. non-alcoholic steatohepatitis (NASH)
6. primary biliary cholangitis, primary sclerosing cholangitis
7. Wilson’s disease
8. chronic R-sided heart failure
9. hemachromatosis
what is the patho for cirrhosis?
- insult to liver ➔ damage to hepatocytes ➔ ROS and inflam mediators
- sinusoidal epithelial cells get inflamed ➔ inflam mediators
- Kupffer cells ➔ insult ➔ inflam mediators
- inflammatory mediators activate the hepatic stellate cells
- transform into myofibroblasts ➔ collagen synthesis
- collagen ➔ fibrosis in perisinusoidal space
- liver attempts to compensates ➔ regenerative nodules
explain compensated cirrhosis
liver can still function
normally dx incidentally with lab work of imaging
may have nonspecific signs like weakness, fatigue and wt loss
generally what is decompensated cirrhosis?
liver can no longer keep up with its functions
in decompensated cirrhosis what s/s develop from the intrahepatic fibrosis?
portal HTN
1. esophageal varies
2. caput medusa - dilated veins around the umbilicus
3. splenomegaly ➔ anemia/pancytopenia bc spleen sequestration
4. congestive heart failure
5. ascites
6. umbilical hernia
in decompensated cirrhosis, what s/s develop from the decreased liver synthetic function?
- decreased albumin in lab work
- more fluid retention - pitting edema, anascarca, ascites
- easy bruising, thrombocytopenia, impaired coagulation, DIC
in decompensated cirrhosis, what s/s develop from poor liver detoxification function?
- hepatic encephalopathy bc build-up of ammonia ➔ asterixis, DLOC
- hyperestrogenemia bc decreased estrogen metabolism ➔ gynecomastia, spider angiomas, palmar erythema
what cx sequela from ascites do we need to be concerned about?
bacterial peritonitis - infected ascites from bacterial translocation from the gut
what it the gold standard ix for cirrhosis?
liver biopsy
need to be careful re: sampling error
what ix would you order for a RUQ pain and jaundice query cirrhosis?
- liver tests - AST/ALT (potentially elevated, may be normal bc liver in fibroses state vs inflamed state) /ALP/GGT (isolate elevation expected in alcohol use)
- albumin
- PT/INR
- bilirubin
- CBC
determine etiology
1. u/s abdo
2. imaging CT/MRI query HCC/malignancy
3. hepatitis serology - hep B and C, and autoimmune
4. ferritin and iron panel
what does the child-pugh score tell you?
gives you a grade for liver transplant mortality ➔ gives you rate of 1-year survival
class A = 100% 1-year survival
class B = 80%
class C = 45%
what factors are involved in child-pugh score calculation?
- total bilirubin
- serum albumin
- PT/INR
- Ascites
- Hepatic encephalopathy
how do you manage decompensated cirrhosis pt?
- treat underlying etiology - adjust meds to be liver friendly, stop alcohol, vaccines for hep, surgery, wt reduction, nutrition etc.
- pain management re: cx
- fluid management diuretics
- consider liver transplant based on child-pugh score
what sort of workup would you do for a newly diagnosed cirrhosis pt?
- EGD - to get a baseline on potential varices
- baseline liver tests (ALT/AST/ALP/GGT)
- bilirubin, albumin
- PT/INR
- imaging of the liver
- liver biospy
- hepatitis serology and hep b vaccinations
